ATHENS, Ohio -- Simple muscle relaxation techniques may help people with
Alzheimer's disease control some behavioral problems associated with the
disorder while improving their mental performance, according to a new study by
an Ohio University researcher.

By helping patients control anxiety, aggression and irritability, the
techniques could decrease health care costs and caregiver stress and allow
patients to remain at home instead of being moved to a long-term care facility,
said Julie Suhr, assistant professor of psychology at Ohio University and lead
author of the study.

"Studies suggest that behavioral problems are the reason many people
become institutionalized," Suhr said. "It's not the memory problems. It's these
other difficult-to-manage behaviors that make it hard for a caregiver to keep
their loved one at home."

Most Alzheimer's patients take psychotropic medication for behavioral
problems, but these drugs can have negative side effects ranging from drowsiness
to increased confusion. Other researchers have examined relaxation therapy as a
treatment for all types of stress-related problems, but few have studied the
technique's use in Alzheimer's patients, Suhr said.

"The failure to use behavioral or psychological interventions in
demented populations appears to stem, at least in part, from the belief that the
memory impairment of Alzheimer's disease patients precludes their learning new
skills or behavioral repertoires," she said.

Suhr studied two forms of relaxation training in 34 pairs of Alzheimer's
patients and caregivers. The patients ranged in age from 65 to 80, were living
at home, exhibited behavioral problems that affected daily functioning and had
mild to moderate cognitive impairments.

Participants were randomly assigned to either a progressive muscle
relaxation training group or a group that used an imagery technique to promote
relaxation. With progressive muscle relaxation, patients were trained to tense
and relax various groups of muscles. Using the imagery method, patients
visualized a calm setting when they began to feel agitated or anxious.

Caregivers in both groups were trained to coach patients through the
prescribed relaxation technique at the first sign of aggression or anxiety.

Participants had an average of five treatment sessions with Suhr and
practiced at home at least twice a day for six weeks. Caregivers kept diaries of
patient activities, response to the relaxation techniques and any changes in
behavior.

During the study, some caregivers developed cues to help patients begin
their relaxation techniques. Most people used verbal cues, but one woman tried a
different tactic. When her husband was becoming agitated or nervous, she would
gently squeeze his shoulder, silently telling him to begin his relaxation
technique.

After two months, both groups reported a decrease in anxiety symptoms,
but only patients in the progressive muscle relaxation group reported fewer
behavioral problems. Patients in this group also showed improvement on
laboratory tests that measure memory, suggesting that reducing anxiety may make
it easier for patients to think more clearly.

"The results we saw in the group that used progressive muscle relaxation
suggest that it may be a useful technique to add to a multidisciplinary
intervention designed to address all aspects of the behavior disorder seen in
Alzheimer's disease," Suhr said.

Suhr conducted the study as a postdoctoral researcher at the University
of Iowa. She wants to continue the work at Ohio University, exploring the
effectiveness of progressive muscle relaxation on patients with advanced
Alzheimer's disease, including patients living in residential care facilities.
Suhr would also like to investigate the long-term effects of relaxation training
as the disease progresses.

"Progressive relaxation training has the potential to minimize
catastrophic reactions and excess disability in an inpatient Alzheimer's disease
population, and this may help with professional caregiver burnout, as well as
minimize the use of psychotropic medication," she said.

Co-authors of the study, which was supported by the National Institute
of Aging and presented at a recent meeting of the International
Neuropsychological Society in Honolulu, were Steven Anderson and Daniel Tranel
at the University of Iowa College of Medicine.

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